[睡眠鼻内镜检查及Müller动作在悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征中的预测价值]

[Predictive value of sleep nasendoscopy and the Müller maneuver in uvulopalatopharyngoplasty for the obstructive sleep apnea syndrome].

作者信息

Li Wuyi, Ni Daofeng, Jiang Hong, Zhang Lianshan

机构信息

Department of Otolaryngology, Peking Union Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730.

出版信息

Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2003 Mar;17(3):145-6.

PMID:12815890

Abstract

OBJECTIVE

To improve the therapy effect of uvulopalatopharyngoplasty (UPPP) for the obstructive sleep apnea syndrome (OSAS) with the use of sleep pharyngolaryngoscopy and the Müller maneuver to localize pharyngeal airway collapse.

METHOD

Twenty-eight patients with OSAS were divided into two groups respectively based on findings of Müller maneuver and sleep pharyngolaryngoscopy: Type I had only oropharyngeal(soft palate and palatine tonsil) collapse and type II had oropharyngeal collapse with hypopharyngeal collapse. All outcome of PSG after UPPP was analyzed.

RESULT

In Type I, the change of the average apnea hypopnea index (AHI) and the lowest SaO2 before and after UPPP was 52.7 to 19.7 (P < 0.01), 63.1% to 80.0% (P < 0.01) using Müller maneuver, and 48.6 to 18.7(P < 0.01), 65% to 80%(P < 0.01) using sleep pharyngolaryngoscopy respectively; In type II, the change was respectively 54.7 to 38.6(P > 0.05), 60.7% to 67.0%(P > 0.05) using Müller maneuver, and 59 to 34(P < 0.01), 59% to 71%(P < 0.05) using sleep pharyngolaryngoscopy. 2. Surgical response rate in type I was compared with type II: 68.4% VS 22.2% (P < 0.01) using Müller maneuver and 73.3% VS 30.8% (P < 0.05) using sleep pharyngolaryngoscopy, respectively.

CONCLUSION

Endoscopic pharyngeal assessment of OSAS patients has clinical value for the improvement of UPPP outcome.

摘要

目的

运用睡眠期咽喉镜检查和米勒动作来定位咽气道塌陷，以提高悬雍垂腭咽成形术（UPPP）治疗阻塞性睡眠呼吸暂停综合征（OSAS）的疗效。

方法

根据米勒动作和睡眠期咽喉镜检查结果，将28例OSAS患者分为两组：I型仅存在口咽（软腭和腭扁桃体）塌陷，II型存在口咽塌陷合并下咽塌陷。分析UPPP术后多导睡眠图（PSG）的所有结果。

结果

在I型中，使用米勒动作时，UPPP术前术后平均呼吸暂停低通气指数（AHI）的变化为52.7至19.7（P<0.01），最低血氧饱和度（SaO2）从63.1%升至80.0%（P<0.01）；使用睡眠期咽喉镜检查时，分别为48.6至18.7（P<0.01），65%至80%（P<0.01）。在II型中，使用米勒动作时，变化分别为54.7至38.6（P>0.05），60.7%至67.0%（P>0.05）；使用睡眠期咽喉镜检查时，分别为59至34（P<0.01），59%至71%（P<0.05）。2. I型与II型的手术有效率比较：使用米勒动作时为68.4%对22.2%（P<0.01），使用睡眠期咽喉镜检查时为73.3%对30.8%（P<0.05）。